Urgent gynecology: a new look

To improve the diagnostics and treatment of urgent gynecological diseases 1000 patients with the pathology were examined. 700 women were subjected to laparoscopy. The following structure of acute gynecological diseases was defined: 47% ectopic pregnancy, 24% acute inflammatory diseases of adnexa uteri, 17% ovarian apoplexy, 7% torsion of ovarian cyst pedicle, 4% uterine myoma associated with the disturbances of alimentation of the ganglion, 1% perforation of the uterus. On the basis of the analysis of complains, anamnesis, clinical symptoms and results of supplementary examinations the algorithm of management of patients with suspected acute gynecological diseases including diagnostic laparoscopy was elaborated

Tubo-Ovarian Inguinal Hernia with Ruptured Bleeding Follicle: A Case Report

Introduction: Hernias are abnormal protrusions of any abdominal-pelvic or fat organ, which are produced by a defect in the abdominal wall, the most frequent are inguinal hernias and their content is generally of the omentum or intestinal loops, the presence of pelvic organs is very infrequent and the majority of cases described are in children under five years of age. Objective: To analyze the entity in connection with a case of a patient with a tubo-ovarian inguinal hernia. Clinical case: The case of a 34-year-old female patient is presented, who was under follow-up by the gynecology service due to the presence of a left ovarian cyst, with symptoms of pain in the left iliac fossa for more than 6 months of evolution. which is performed an ultrasound, which reports left inguinal hernia for what is electively scheduled by the general surgery service, when performing the herniorrhaphy incarcerated hernia with left ovary with bleeding follicle and fallopian tube is evidenced. Conclusions: These types of findings are infrequent, documented in the literature with a global incidence of Tubo-ovarian inguinal hernias ranging from 0-8-4.4%, however it is worth clarifying that these studies are in infant patients, so its presentation in adults associated with a hemorrhagic follicle is anecdotal as in this case.

A huge mesenteric teratoma in reproductive age woman: a case report

The incidence of dermoid ovarian cyst is 15-20% of all ovarian neoplasm, which is a common entity. Mesenteric cyst are one of the very rare entities with incidence of 1 in 2, 50, 000. Dermoid cysts rarely present as mesenteric cysts. Mesenteric dermoid cyst have good prognosis. Here, we report a rare abdominal tumor which was initially diagnosed clinically as an ovarian dermoid cyst but operative and histology revealed it to be mesenteric dermoid cyst. A 36 year-old, multiparous presented with abdominal mass, gradually increasing in size since 1 year with recent onset of abdominal pain. Physical examination revealed abdominal mass of 22×20 cm size, globular, non-tender, mobile, and cystic to solid in consistency. Contrast-enhanced computed tomography (CECT) showed 23×21×14.4 cm heterogeneous enhancing mass lesion with areas of fat density and calcifications within, suggestive of neoplastic mass lesion, likely teratoma. Tumor markers were within normal limit. Patient was managed surgically. Laparotomy findings revealed a huge solid mesenteric mass (22×20 cm) weighing 6.5 kgs. Histopathology showed mature cartilage, osteoid formation, fibro-adipose connective tissue, focal lymphoid aggregates, congested blood vessels and focal mature neuronal component and no immature elements seen, confirming dermoid cyst. Mesenteric cyst are rare intra-abdominal tumor found most commonly in ileum (60%) next is ascending colon (40%). However, if a mesenteric cyst locates within the pelvic cavity, as in this case, it may be misdiagnosed as an ovarian cyst.

Laparo-endoscopic Approach for Large Ovarian Cyst in the Morbidly Obese: Case Report

We report a successful case of laparo-endoscopic single site total hysterectomy and bilateral salpingo-oophorectomy (LESS THBSO) using conventional laparoscopic instruments for a large ovarian cyst in a morbidly obese woman. A 58-year-old female with a BMI of 46kg/m2 complaint of abdominal distension. A pelvic ultrasound revealed a left ovarian cyst measuring 21.3 x 15.2 x 20.8 cm. The IOTA score is 3.5% and the RMI score was 51, suggesting a benign pathology. LESS THBSO was performed and the final histology was a benign ovarian mucinous cystadenoma. The patient recovered well with no postoperative complications. This case demonstrates that LESS is feasible for large ovarian cysts even in morbidly obese patients when appropriate cases are selected and when the patient is managed in a multi-disciplinary team.

Removal of a Giant Cyst of the Left Ovary from a Pregnant Woman in the First Trimester by Laparoscopic Surgery under Spinal Anesthesia during the COVID-19 Pandemic

This paper reports a case of a 21 year old primigravida at 6 weeks gestation, suffering from important abdominal pain, who was admitted into the medical center with a giant cyst of 28 × 20 cm on her left ovary. A torsion of the ovarian cyst was suspected. Her COVID-19 status was unknown. In view of the emergency of the situation and the COVID-19 pandemic, laparoscopy in spinal anesthesia was performed. The patient remained conscious during the surgical intervention and tolerated it well apart from a slight dyspnea, which was easily eliminated by changing her body position and decreasing the pneumoperitoneum pressure. The ovarian cyst was removed by enlarging the trocar incision. The patient recovered with neither incident nor pregnancy loss. COVID-19-related complications can induce adverse pregnancy outcomes. Under general anesthesia, patients with COVID-19 are at risk of severe pneumonia and of passing their infection to the medical personnel. To avoid such complications in non-specialized centers, laparoscopy should be performed in regional anesthesia. Laparoscopy in spinal anesthesia can be performed safely on pregnant patients by placing them in the proper position, using a low pneumoperitoneum, and monitoring the hemodynamics. During early pregnancy, general anesthesia induces a higher risk of teratogenic effects and of miscarriage.